Healthcare Provider Details

I. General information

NPI: 1417902610
Provider Name (Legal Business Name): STEPHEN L PILON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 WILWAY AVE NE
ALBUQUERQUE NM
87106-1942
US

IV. Provider business mailing address

3325 WILWAY AVE NE
ALBUQUERQUE NM
87106-1942
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-1810
  • Fax: 505-262-1810
Mailing address:
  • Phone: 505-262-1810
  • Fax: 505-262-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number94-355
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: